Focused summary (2021) of updated guidelines for asthma management of children ages 5 to 11 years

Asthma guidelines provide evidenced-based recommendations for clinical management of asthma, and use of current guidelines is associated with better patient outcomes. This brief two-sided printable brochure provides a concise summary of current treatment guidelines by age group, and offers guidance on assessing and managing asthma for clinicians. The summary is based off of EPR3, EPR4 (2020), GINA (2020) updates, and other current asthma literature. Recommendations are current to version date shown on the guide. Guides will be periodically updated to reflect changes to practice. References: National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the diagnosis and management of asthma. Bethesda, Md.: National Heart Lung and Blood Institues, National Institutes of Health, Publication No. 08-5846; 2007. National Heart Lung and Blood Institues [NHLBI]. Asthma care quick reference. Bethesda, Md.: National Asthma Education and Prevention Program; 2011. National Asthma Education and Prevention Program. Expert Panel Report 4: 2020 Focused Updates to the Asthma Management Guidelines from: https://www.nhlbi.nih.gov/health-topics/asthma-management-guidelines-2020-updates 2020 GINA Report, Global Strategy for Asthma Management and Prevention: Pocket Guide for Asthma Management and Prevention. From: https://ginasthma.org/pocket-guide-for-asthma-management-and-prevention

Focused summary (2021) of updated guidelines for asthma management of adults and children ages 12+

Asthma guidelines provide evidenced-based recommendations for clinical management of asthma, and use of current guidelines is associated with better patient outcomes. This brief two-sided printable brochure provides a concise summary of current treatment guidelines by age group, and offers guidance on assessing and managing asthma for clinicians. The summary is based off of EPR3, EPR4 (2020), GINA (2020) updates, and other current asthma literature. Recommendations are current to version date shown on the guide. Guides will be periodically updated to reflect changes to practice. References: National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the diagnosis and management of asthma. Bethesda, Md.: National Heart Lung and Blood Institues, National Institutes of Health, Publication No. 08-5846; 2007. National Heart Lung and Blood Institues [NHLBI]. Asthma care quick reference. Bethesda, Md.: National Asthma Education and Prevention Program; 2011. National Asthma Education and Prevention Program. Expert Panel Report 4: 2020 Focused Updates to the Asthma Management Guidelines from: https://www.nhlbi.nih.gov/health-topics/asthma-management-guidelines-2020-updates 2020 GINA Report, Global Strategy for Asthma Management and Prevention: Pocket Guide for Asthma Management and Prevention. From: https://ginasthma.org/pocket-guide-for-asthma-management-and-prevention

Mapping meaningful symptoms and impacts of early Parkinson\u27s disease to digital outcome measures

Background: Digital health technologies have the potential to capture fine variations in symptoms across a range of diseases. However, it is not clear whether these measures are meaningful to patients, which is critical to guiding the selection of digital endpoints. Objective: This manuscript describes novel methodology for mapping meaningful symptoms and impacts of disease and assessing personal relevance of digital measures from the patient perspective. Methods: Participants with early Parkinson’s from the WATCH-PD study [NCT03681015] completed online surveys (N=65), with a subset recruited for 1:1 online video-interviews (N=40) to explore symptoms, impacts and perceived relevance of selected digital measures. Interviews included: (1) symptom mapping to delineate and rank meaningful symptoms/impacts of Parkinson’s, (2) cognitive interviewing on digital measures administered in the WATCH-PD study, and (3) mapping of these measures back to the personal symptom map to show relevance from the patient perspective. Content coding was used to assess frequencies and bothersomeness of symptoms/impacts, and perceived relevance of the technology. Thematic analysis was performed for narrative transcripts. Copies of maps were shared with participants. Results: This approach was deeply engaging and satisfying to participants, who reported improved ability to describe and discuss their symptom experiences. Maps and interviews provided detailed qualitative data on symptoms/impacts of early Parkinson’s with concurrent ability to quantify symptom frequencies and bothersomeness along with perceived relevance of the digital measures. Conclusion: Combining symptom mapping with cognitive interviewing can improve understanding of meaningful symptoms and impacts of disease and perceived relevance of digital measures from the patient perspective

Relative meaningfulness and impacts of symptoms in people with early-stage Parkinson’s disease

Background: Patient perspectives on meaningful symptoms and impacts in early Parkinson’s disease (PD) is lacking, and is urgently needed to clarify priority areas for monitoring, management, and new therapies. Objective: To examine experiences of people with early-stage PD, systematically describe meaningful symptoms and impacts, and determine which are most bothersome or important. Methods: Forty adults with early PD (≤ 2 years diagnosis) who participated in a study evaluating smartwatch and smartphone digital measures (WATCH-PD study) completed online interviews with symptom mapping to hierarchically delineate symptoms and impacts of disease from “Most bothersome” to “Not present,” and to identify which of these were viewed as most important and why. Individual symptom maps were coded for types, frequencies, and bothersomeness of symptoms and their impacts, with thematic analysis of narratives to explore perceptions. Results: The three most bothersome and important symptoms were tremor, fine motor difficulties, and slow movements. Symptoms most commonly impacted sleep, job functioning, exercise, communication, relationships, and self-concept—expressed as a sense of being limited by PD. Thematically, most bothersome symptoms were those that were personally limiting with broadest negative impact on well-being and activities. However, symptoms could be important to patients even when not present, bothersome, or limiting (e.g., speech, cognition). Conclusion: Meaningful symptoms of early PD can include symptoms that are present or anticipated future symptoms that are important to the individual. Systematic assessment of meaningful symptoms should aim to assess the extent to which symptoms are personally important, present, bothersome, and limiting

Summary of the 2020 focused updates to U.S. Asthma Management Guidelines: What has changed and what hasn\u27t?

Despite the availability of effective medications, the majority of pediatric and adult patients with persistent asthma have uncontrolled symptoms. This has been attributed to patient nonadherence and poor self-management, but clinicians also contribute through inaccurate assessment of asthma and lack of familiarity with best practice guidelines for medication management. Thus, improving patient outcomes will require improving clinical management by health care providers, including utilization of evidence-based practice guidelines. In this report, we briefly summarize key points of the national guidelines for asthma management and delineate important changes enacted by 2020 Expert Panel Report-4 updates. These include revised recommendations on the use of fractional exhaled nitric oxide testing, indoor allergen mitigation, bronchial thermoplasty, adjunctive immunotherapy, and important modifications to medication management that are likely to have widespread impact on prescribing throughout the United States. In particular, for all patients aged five years and older taking stepwise therapy levels 3–4, it is now recommended to use Single Maintenance and Reliever Therapy, whereas the use of intermittent inhaled corticosteroids (ICSs) administered at the same time as short-acting beta agonist is recommended for step 2 to reduce symptom burden, improve control, and minimize total ICS dose

Understanding the genetics of chronic obstructive pulmonary disease, α1-antitrypsin deficiency, and implications for clinical practice

Cigarette smoking and poor air quality are the greatest risk factors for developing chronic obstructive pulmonary disease (COPD), but growing evidence indicates that genetic factors also affect predisposition to and clinical expression of disease. With the exception of α1-antitrypsin deficiency (AATD), a rare autosomal recessive disorder that is present in 1–3% of individuals with COPD, no single gene is associated with the development of obstructive lung disease. Instead, a complex interplay of genetic, epigenetic, and environmental factors is the basis for persistent inflammatory responses, accelerated cell aging, cell death, and fibrosis, leading to the clinical symptoms of COPD and different phenotypic presentations. In this brief review, we discuss current understanding of the genetics of COPD, pathogenetics of AATD, epigenetic influences on the development of obstructive lung disease, and how classifying COPD by phenotype can influence clinical treatment and patient outcomes

Smartphone guide to asthma self-management ages 5 to adult (patient education materials)

This free, colorful, interactive, and evidence-based PDF is designed to support online or in-person education about asthma, with formatting that is smartphone friendly. The patient teaching guide covers key content of asthma self-management education in 15 single-page mini-modules. Help your patients to understand what really asthma is, how uncontrolled asthma scars the lungs, different types of asthma medications, and how to use them correctly. Also includes a customizable action plan and a patient friendly asthma attack algorithm. Text it, email it, fill it in and make it your own! English Version. References: Mammen JR, Rhee H, Atis S, Grape A. Changes in asthma self-management knowledge in inner city adolescents following developmentally sensitive self-management training. Patient Education & Counseling 2018;101:687-95. Mammen JR, Java JJ, Halterman J, et al. Development and preliminary results of an Electronic Medical Record (EMR)-integrated smartphone telemedicine program to deliver asthma care remotely. J Telemed Telecare 2019;0:1-14 Mammen JR, Schoonmaker JD, Java JJ, et al. Going mobile with primary care: Smartphone-telemedicine for asthma management in young urban adults (TEAMS). . Journal of Asthma 2020;0. PLEASE NOTE: This form does not work in Safari and may be corrupted by Safari download. Please use Google Chrome or other browser to access and download

Evaluation of human dental stem cell growth characteristics and cellular morphological changes in response to extracellular matrix nanotopography

Objetivo: Nanotopografia e fatores extracelulares solúveis estão presentes nas célulastroncoda polpa dentária Seu efeito na sobrevivência e diferenciação de células-tronco dentárias ainda não foi estabelecido. Nosso objetivo foi analisar os papéis individuais e combinados da nanotopografia e do soro (fatores solúveis) da matriz extracelular (MEC) no crescimento, potencial de diferenciação e características morfológicas das células-tronco da polpa dentária humana. Este estudo avaliou e comparou a resposta detais células-tronco a diferentes estímulos ambientais – nanofibras, soro e meios condicionados. Materiais e métodos: Neste estudo, nanofibras de PLLA fabricadas foram usadas como meio biomimético estrutural in vitro da nanotopografia nativa encontrada na polpa de células-tronco/MEC in vivo. O soro e o meio condicionado foram utilizados como o imitador in vitro dos fatores solúveis aos quais as células-tronco são expostas in vivo. As células-tronco foram cultivadas na presença e ausência de nanofibras de ácido poli-L lático biodegradáveis e soro. As características de crescimento das células-tronco da polpa dentária humana foram avaliadas em termos de viabilidade celular e tempo de duplicação no intervalo de cada passagem. As alterações morfológicas celulares foram estudadas usando microscopia invertida e coloração H&E. Como segunda parte do estudo, as células em todas as condições de cultura foram expostas ao Meio Condicionado para Polpa Dentária (MCPD) por um curto período de 3 dias. As características de crescimento e as alterações morfológicas das células foram avaliadas após a exposição curta ao MCPD. Além disso, a microscopia eletrônica de varredura foi utilizada para o estudo morfológico das células-tronco em nanofibras, expostas aos meios condicionados. As células diferenciadas foram analisadas por TR-PCR quantitativa quanto à expressão neurogênica e odontogênica dos genes RUNX2, osteopontina e β-tubulina III. Resultados: As células-tronco dentárias apresentaram melhor sobrevida e proliferação na presença de nanofibras e soro. A ausência de nanofibras ou soro alterou a sobrevivência e proliferação de células-tronco de forma significativa e indicou diferenciação. Além disso, observou-se que, após a exposição curta ao MCPD, a presença de nanofibras e soro de PLLA favoreceu maior potencial de diferenciação odontogênica e neurogênica, sem alterações morfológicas características da diferenciação terminal. Conclusão: Células-tronco da polpa dentária humana são capazes de detectar sinais geométricos em nanoescala de seu microambiente. Nanotopografia e fatores solúveis da matriz extracelular afetam as células-tronco. Estudos adicionais são essenciais para identificar os principais caminhos que desempenham um papel vital nessas interações.Objective: Nanotopography and soluble extracellular factors are present in the dental stem cell niche in the pulp. Their effect on dental stem cell survival and differentiation is yet to be established. We aimed to analyze the individual and combined roles of extracellular matrix (ECM) nanotopography and serum (soluble factors) on the growth, differentiation potential, and morphological characteristics of the human dental pulp stem cells (hDPSC). This study aimed to evaluate and compare the hDPSC response to different environmental cues – nanofibers, serum, and conditioned media. Materials and methods: In this study, fabricated PLLA nanofibers were used as the in vitro structural biomimetic of the native nanotopography found in the in vivo ECM/stem cell niche. Serum and conditioned media were used as the in vitro mimic of the soluble factors to which stem cells get exposed in vivo. hDPSC were grown in the presence and absence of biodegradablepoly-L-lactic-acid nanofibers and serum. The growth characteristics of hDPSC were assessed in terms of cell viability and doubling time at the interval of every passage. Cellular morphological changes were studied using inverted microscopy and H&E. As the second part of the study, hDPSC in all culture conditions were exposed to Dental Pulp Conditioned Media (DPCM) for a short duration of 3 days. After transient exposure to DPCM, the growth characteristics and the morphological changes of hDPSC were assessed. In addition, scanning electron microscopy was used for the morphological study of hDPSC on nanofibers, exposed to conditioned media. The differentiated cells were analyzed by qRT-PCR for neurogenic and odontogenic expression of RUNX2, osteopontin, and β-tubulin III genes. Results: hDPSC showed better survival and proliferation in the presence of nanofibers and serum. Absence of nanofibers or serum greatly altered stem cell survival and proliferation and also indicated differentiation. In addition, it was observed that after transient exposure to DPCM, the presence of both PLLA nanofiber and serum favoured higher odontogenic and neurogenic differentiation potential, without characteristic morphological changes of terminal differentiation. Conclusion: hDPSC has the ability to sense nanoscale geometric cues from their microenvironment. Nanotopography and soluble factors of the extracellular matrix both affect hDPSC. Further studies are essential to identify the key pathways that play a vital role in such interactions. The hDPSC demonstrated better survival and proliferation in the presence of nanofibers and serum. Absence of nanofibers or serum greatly altered stem cell survival and proliferation and also showed changes indicative of differentiation. The results were compared and analyzed using GraphPad Prism 5 Software. hDPSC possess the ability to sense nanoscale geometric cues from their microenvironment. Nanotopography and soluble factors of the Extracellular matrix together influence the fate of hDPSC. Further studies are essential to identify the key pathways that play a vital role in such interactions

Nipple aspirate cytology and pathologic parameters predict residual cancer and nodal involvement after excisional breast biopsy

We previously demonstrated that abnormal nipple aspirate fluid (NAF) cytology predicted residual breast cancer (RC) and tumour size after excisional biopsy (EB), although normal NAF cytology did not exclude RC. Tumour size correlates with the risk of lymph node (LN) metastases. LN metastases provide prognostic information allowing medical and radiation oncologists to determine the need for adjuvant therapy. We hypothesized that pathologic factors known after EB, combined with NAF cytology, would predict with a high degree of accuracy the presence of RC and LN spread. NAF cytology and pathologic parameters: tumour distance from biopsy margins, multifocal and multicentric disease, sub-type of ductal carcinoma in situ (DCIS) or invasive cancer (IC), grade of DCIS or IC, tumour and specimen size, tumour and biopsy cavity location, presence or absence of extensive DCIS, and biopsy scar distance from the nipple were evaluated bivariately and then by logistic regression (LR) for their association with RC and involved LN (≥ 1 (+) LN, useful to determine chemotherapy need, and ≥ 4 (+) LN, useful to determine radiation need to the chest and axilla). Data were analysed using NAF cytology alone, pathologic parameters alone, and NAF cytology and pathologic parameters combined. The combined LR model was superior in predicting residual cancer (94%) to LR models using NAF cytology (36%) or pathologic parameters (75%) alone. When only subjects with normal NAF cytology were evaluated by LR, the model was 92% sensitive in predicting RC. Tumour size and NAF cytology predicted which patients had ≥ 1 (+) LN, whereas tumour and specimen size predicted which patients had ≥ 4 (+) LN. We propose an alogorithm which, if confirmed in a larger study, may allow clinicians to be more selective in their recommendations of re-excision breast biopsy or mastectomy. © 2001 Cancer Research Campaign http://www.bjcancer.co